Abstract: PUB221
Safety of the Placement of Tunneled Catheters for Hemodialysis Inserted under Ultrasound Guidance without Fluoroscopy
Session Information
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Rivera Flores, Javier, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
- Arvizu Hernández, Mauricio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
Background
The installation of a tunneled access for hemodialysis traditionally requires fluoroscopy; however, in Mexico, the availability of this instrument is limited. The objective of the study is to determine if the placement of tunneled catheters for hemodialysis without fluoroscopy is safe using ultrasound guidance and calculating the intravascular portion based on the patient's height.
Methods
This is a retrospective, observational, and descriptive study conducted at the National Institute of Medical Sciences and Nutrition Salvador Zubirán. Patients who received a tunneled vascular access without the use of fluoroscopy, only using real-time ultrasound guidance . The intravascular portion of the catheter was calculated by considering the patient's height in centimeters and dividing it by 10. A chest X-ray was performed to corroborate the appropriate path and position of the catheter tip, distinguishing four locations: cavo-atrial junction, right atrium, deep portion of the right atrium, right ventricle, and any other location.
Results
A total of 317 tunneled access placements without fluoroscopy were performed between january 2018 to december 2023 ;in 99% the indication was chronic hemodialysis. 167 were women (52.6%) and 150 were men (47.4%). In 291 patients (91.8%), the right jugular vein was used, in 25 patients (7.9%) the left jugular vein was used, and only 1 femoral access (0.3%). No vascular or pleuropulmonary injuries were reported.The catheter tip was located at the cavo-atrial junction in 59 patients (18.6%), in the right atrium in 231 patients (72.9%); in 20 patients (6.3%) the tip was observed in the deep portion of the right atrium or right ventricle and was retracted to locate it in the right atrium. The tip was located in another anatomical region in 7 patients (2.2%), in which cases replacement by the Interventional Radiology team was necessary. All accesses showed immediate adequate functionality.
Conclusion
The placement of tunneled catheters for hemodialysis with ultrasound guidance without fluoroscopy is safe and cost-effective. The calculation of the intravascular portion considering height allowed the tip to be located in the right atrium in 72.9% of the catheters. The placement was considered successful based on the tip location and AV functionality in more than 98% of cases.